Conclusion
In our case, we describe a patient with a pancreatic tumor associated with a giant hiatal hernia that had prolapsed into the posterior mediastinum. The patient was safety managed by undergoing hiatal hernia repair, followed by laparoscopic distal pancreatectomy. In simultaneous hiatal hernia repair and distal pancreatectomy, understanding the anatomy is difficult because of the displacement of the pancreas. Therefore, hiatal hernia repair should be performed first because it enables laparoscopic distal pancreatectomy to be performed in the normal anatomical position.